title: Sex disparities in overall burden of disease among HIV-infected individuals in the Veterans Affairs healthcare system.
abstract: BACKGROUND
  Whether sex disparities exist in overall burden of disease among human immunodeficiency virus (HIV)-infected individuals in the Veterans Affairs healthcare system (VA) is unknown.
  
  
  OBJECTIVE
  To determine whether sex differences exist in overall burden of disease after 1 year of combined antiretroviral therapy (ART) among HIV-infected individuals in VA.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Among patients in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC), all ART-naïve HIV-infected Veterans who received VA-based HIV care between 1996 and 2009.
  
  
  METHODS
  Overall burden of disease was measured using the VACS Index, an index that incorporates HIV (e.g. CD4 cell count) and non-HIV biomarkers (e.g. hemoglobin) and is highly predictive of all-cause mortality. Possible scores range from 0 to 164, although scores typically range from 0 to 50 for 80 % of patients in VACS-VC. A higher score indicates greater burden of disease (each additional five points indicates approximately 20 % increased 5-year mortality risk). ART adherence was measured using pharmacy data.
  
  
  RESULTS
  Complete data were available for 227 women and 8,073 men. At ART initiation, compared with men, women were younger and more likely to be Black, less likely to have liver dysfunction, but more likely to have lower hemoglobin levels. Median VACS Index scores changed from ART initiation to 1 year after ART initiation: women's scores went from 41 to 28 for women (13 point improvement) and men's from 42 to 27 for men (15 point improvement). In multivariable regression, women had 3.6 point worse scores than men after 1 year on ART (p = 0.002); this difference decreased to 3.2 points after adjusting for adherence (p = 0.004).
  
  
  CONCLUSIONS
  In VA, compared to men, women experienced less improvement in overall burden of disease after 1 year of HIV treatment. Further study is needed to elucidate the modifiable factors that may explain this disparity.
authors.affiliation: Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. oblackst@montefiore.org
authors.forename: Oni J
authors.initials: OJ
authors.lastname: Blackstock
authors.forename: Janet P
authors.initials: JP
authors.lastname: Tate
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Akgün
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.forename: Mona
authors.initials: M
authors.lastname: Duggal
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Kirsha S
authors.initials: KS
authors.lastname: Gordon
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wang
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012727:Sex Characteristics; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans; D058014:Veterans Health / Q000639:trends*